Tibia-talus-calcaneus (T-T-C) locking plate

Abstract

Disclosed is a bone fusion or implant, method and system for arthrodesis of a human ankle fusing the distal end of a tibia, talus and/or a calcaneus bone by employing a single anatomically lateral incision to the tibia, fibula, talus and calcaneus region, removing some or all of a fibula in the incision area and attaching the implant to the tibia, talus and/or calcaneus in a generally central area of the ankle. The removed portion of the fibula is morsilized and made into a paste and mixed with an autologous platelet concentrate that is applied as a bone graft to the implant site thereby enhancing the arthrodesis site and enhancing hemostasis.

1 . An implant for inserting into a human ankle for arthrodesis of the distal end of a tibia, a talus and/or a calcaneus comprising;
 a locking-plate and screw fixation device with a thirty degree bend posteriorly on a distal end of said implant wherein the angle is in the range of fifteen to forty five degrees.   
   
   
       2 . The implant of  claim 1 , wherein said implant is biocompatible material comprising titanium, stainless steel or other said biocompatible material and formable to the contour, shape and size of said tibia, said talus and said calcaneus. 
   
   
       3 . The implant of  claim 1 , wherein said implant comprises holes at various locations along said implant and said holes are provided at various angles to said longitudinal surface and said distal end and wherein said holes optionally include interior threads. 
   
   
       4 . The implant of  claim 3 , wherein said holes at various angles guide said fasteners for specific location within said tibia, said talus and/or said calcaneus such that said fasteners are overlapping, parallel, divergent or convergent and said fasteners optionally comprise exterior threads that mate with said interior threads of said holes to secure said fasteners to said implant. 
   
   
       5 . The implant of  claim 1 , wherein said lateral incision to said ankle provides ease of access to said ankle region of said tibia, fibula, said talus and said calcaneus. 
   
   
       6 . The implant of  claim 1 , wherein a portion of said fibula is removed and morsilized or pulverized to form a paste, powder or slurry that may be mixed with an autologous platelet concentrate to form a bone graft. 
   
   
       7 . The implant of  claim 6 , wherein a portion of said removed fibula from the distal end is twelve to fourteen centimeters in length. 
   
   
       8 . The implant of  claim 1 , wherein said fastener is a rod, screw, pin, and/or nail. 
   
   
       9 . The implant of  claim 1 , wherein said implant is in a generally central location and is laterally placed where there is adequate soft tissue coverage. 
   
   
       10 . The implant of  claim 1 , wherein said implant is utilized for the arthrodesis of severe ankle and subtalar arthrosis, talar collapse, avascular necrosis, hindfoot deformity, stage 4 flatfoot and/or Charcot deformity. 
   
   
       11 . The implant of  claim 1 , wherein said lateral incision to said ankle provides ease of access to said ankle region whereby said implant and/or said bone graft may be inserted directly laterally into an anteriolateral and/or posteriolaterial position. 
   
   
       12 . An implant for inserting into a human ankle for arthrodesis of the distal end of a tibia, a talus and/or a calcaneus comprising;
 employing a single anatomically lateral incision to an ankle region of said tibia, fibula, said talus and said calcaneus,   removing some or all of said fibula in said ankle region,   attaching said implant with fasteners to said tibia, said talus and/or said calcaneus in a generally central location within said ankle region thereby fusing said tibia, said calcaneus and/or said talus together stabilizing said ankle,   making a paste derived of any or all of removed said fibula,   applying said paste of said fibula as a bone graft to said implant, said tibia, said talus and/or said calcaneus, thereby enhancing the ability to achieve arthrodesis and hemostasis.   
   
   
       13 . A method for inserting into a human ankle for arthrodesis of the distal end of a tibia, a talus and/or a calcaneus comprising;
 placing a patient on the operating room table in the supine position,   performing an extensive anatomically lateral incision over the fibula exposing the distal end twelve (12) to fourteen (14) centimeters of the fibula   surgically removing and cleaning all soft tissue,   morsilizing and mixing with autologous platelet concentrates thereby forming bone graft providing additional healing in the arthrodesis site,   debriding the T-T-C, T-T or T-C joint surfaces of all articular cartilage so raw bone is exposed for the arthrodesis such that if the talus exhibits avascular necrosis or is destroyed, a tibial-calcaneal arthrodesis can be performed either without an interpositional graft or with an interpositional graft such as a with a femoral head in order to maintain length of the extremity,   placing the foot in alignment with the second metatarsal aligned with the tibial crest and the ankle at zero degrees of dorsiflexon,   providing a temporary Steinman pin placed from the plantar aspect of the heel into the distal tibia,   optionally taking X-rays at this time to-check alignment,   placing cannulated screws from the distal tibial metaphysis across the arthrodesis sites to obtain compression, wherein placing at least one cannulated screw from the distal anterior tibia into the calcaneus posteriorly is accomplished and wherein placing a second screw from the posterior tibia into the medial column of the foot is performed under fluoroscopic guidance and through the single lateral incision site.   
   
   
       14 . The method of  claim 13 , wherein the lateral T-T-C, T-T or T-C locking plate implant is contoured to the patient's anatomy and wherein a large fixed angle locking screw is placed first into the sustentaculum of the calcaneus 
   
   
       15 . The method of  claim 13 , followed by placing polyaxial-screws for additional fixation into the calcaneus and for additional compression placing a non-locking screw by eccentric drilling or applying a compression device to the tibia and applying a plate allowing the remaining fixed angle locking screws to be inserted and secured, followed by evaluating and checking screw lengths and alignment by fluoroscopy. 
   
   
       16 . The method of  claim 13 , wherein using the bone graft harvested from the fibula and processed to fill in any deficits and placed posteriorly through the laterial incision for an extra-articular arthrodesis is performed and wherein tissues are closed in layers and a drain is properly placed to prevent post operative hematoma. 
   
   
       17 . The method of  claim 13 , wherein performing removal of the fibula is performed ensuring there is sufficient soft tissue coverage of the locking plate. 
   
   
       18 . The method of  claim 13 , wherein placing a post-operative dressing is accomplished along with a posterior splint and wherein the drain is left in for 24 to 48 hours. 
   
   
       19 . The method of  claims 13 - 18 , wherein once the operation is complete, dressings are changed and the patient is placed into a non-weight bearing fracture brace until healing has occurred based upon X-ray analysis and wherein standard healing time is approximately six to twelve weeks.